Genesis of Esophageal Pressurization and Bolus Flow Patterns in Patients With Achalasia Esophagus.
Genesis of Esophageal Pressurization and Bolus Flow Patterns in Patients With Achalasia Esophagus.
复制标题
DOI：
10.1053/j.gastro.2018.04.033
复制
发表时间：
2018-08
期刊：
影响因子：
29.4
通讯作者：
Mittal RK
中科院分区：
文献类型：
--
作者：
Park S;Zifan A;Kumar D;Mittal RK
在贲门失弛缓症食管患者中，吞咽引起称为食管加压的同时压力波。我们研究了2型或3型贲门失弛缓症患者的食管增压机制和团注流模式。在吞咽5 ml 0.5 N生理盐水期间，我们同时记录了2型贲门失弛缓症（n=6）或3型贲门失弛缓症（n=8）患者和10名健康受试者（对照组）的高分辨率测压和阻抗和腔内超声图像。对于每次吞咽，将超声图像与压力和阻抗描记对齐，以确定腔和接触压力、推注到达、推注停留时间以及下食管括约肌上方5 cm和10 cm处肌肉厚度的变化。在2型贲门失弛缓症患者中，食管增压与肌肉厚度增加和管腔狭窄相关，但与管腔完全闭合无关（因此，管腔压力）。与对照组相比，由于早期管腔闭合，3型贲门失弛缓症患者吞咽开始后，推注到达食管远端的时间延迟。早期管腔闭合与肌肉厚度的减少有关。与对照组相比，3型贲门失弛缓症患者的推注停留时间较短。在3型贲门失弛缓症患者中，同时压力波的开始总是腔压力，但在收缩期间存在不同的腔压力和接触压力时期，与导致团分段的肌肉厚度增加相关。我们观察到与对照组相比，2型或3型贲门失弛缓症患者的食管增压和团流模式的不同机制。这些发现将增加我们对吞咽困难机制的理解。
In patients with achalasia esophagus, swallows induce simultaneous pressure waves known as esophageal pressurization. We studied the mechanism of esophageal pressurization and bolus flow patterns in patients with type 2 or type 3 achalasia. We recorded high-resolution manometry with impedance and intraluminal ultrasound images concurrently in patients with type 2 achalasia (n=6) or type 3 achalasia (n=8) and in 10 healthy subjects (controls) during swallows of 5 ml, 0.5 N saline. For each swallow, the ultrasound image was aligned with the pressure and impedance tracings to determine cavity and contact pressure, bolus arrival, bolus dwell time, and changes in muscle thickness at 5 cm and 10 cm above the lower esophageal sphincter. In patients with type 2 achalasia, esophageal pressurization was associated with an increase in the muscle thickness and luminal narrowing but not complete luminal closure (therefore, cavity pressure). Bolus arrival time in the distal esophagus, after the onset of a swallow, was delayed in patients with type 3 achalasia compared with controls due to early luminal closure. The early luminal closure was associated with a decrease in the muscle thickness. The bolus dwell time was shorter in patients with type 3 achalasia compared with controls. In patients with type 3 achalasia, the onset of simultaneous pressure wave was always a cavity pressure, but during contraction there were different periods of cavity and contact pressures, in association with increases in muscle thickness that resulted in bolus segmentation. We observed distinct mechanisms of esophageal pressurization and bolus flow patterns in patients with type 2 or type 3 achalasia esophagus compared with controls. These findings will increase our understanding of mechanisms of dysphagia.
登录
查看更多内容
影响因子：
29.4
作者：
Jung, HY;Puckett, JL;Mittal, RK
通讯作者：
Mittal, RK
影响因子：
3.5
作者：
Kim, J. H.;Mittal, R. K.;Bhargava, V.
通讯作者：
Bhargava, V.
影响因子：
2.3
作者：
Sifrim, Daniel;Blondeau, Kathleen
通讯作者：
Blondeau, Kathleen
影响因子：
29.4
作者：
Carlson DA;Lin Z;Kahrilas PJ;Sternbach J;Donnan EN;Friesen L;Listernick Z;Mogni B;Pandolfino JE
通讯作者：
Pandolfino JE
影响因子：
--
作者：
MITTAL, RK;REN, JL;SLUSS, J
通讯作者：
SLUSS, J